Provider Demographics
NPI:1316561178
Name:STOCKTON, MINTORIA LYNETTE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MINTORIA
Middle Name:LYNETTE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 OLD KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9065
Mailing Address - Country:US
Mailing Address - Phone:919-266-6211
Mailing Address - Fax:919-350-9824
Practice Address - Street 1:901 OLD KNIGHT RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9065
Practice Address - Country:US
Practice Address - Phone:919-266-6211
Practice Address - Fax:919-350-9824
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily